Rationale
During the coronavirus disease pandemic, audio‐only and video telehealth visits became more widely available, but the relative patient satisfaction between telehealth and in‐person ...modalities is not well‐described.
Aims and Objectives
Our objective was to compare patient satisfaction with audio‐only, video, and in‐person adult primary care visits at a large, urban public healthcare system.
Methods
In this cross‐sectional study, we used aggregated data from Press Ganey patient satisfaction surveys at 17 primary care facilities at New York City Health + Hospitals for visits between 1 June 2021 to 30 November 2021. We compared mean scores for questions common to surveys for each modality in domains of Access, Care Provider, and Overall Assessment using pairwise comparisons with two‐tailed t‐tests.
Results
There were 7,183/79,562 (9.0%) respondents for in‐person visits and 1,009/15,092 (6.7%) respondents for telehealth visits. Compared to respondents for in‐person visits, respondents for telehealth visits were more likely to be aged 35–64 years, Asian, and speak English as their primary language, and less likely to be ≥65 years old, Black or other race, and speak Spanish or another language as their primary language (p < 0.001). Patients reported higher mean satisfaction for Access measures for telehealth visits than in‐person visits (p < 0.001). For Care Provider satisfaction questions, video visits generally had higher mean scores than in‐person and, in turn, audio‐only visits. For Overall Assessment questions, video visits had higher mean scores than in‐person and, subsequently, audio‐only visits.
Conclusion
Of the visit modalities, video visits had the highest mean satisfaction scores across all domains. Telehealth may improve experiences with access, but audio‐only visits may provide poorer visit experiences.
Macrophage-mediated programmed cell removal (PrCR) is a process essential for the clearance of unwanted (damaged, dysfunctional, aged, or harmful) cells. The detection and recognition of appropriate ...target cells by macrophages is a critical step for successful PrCR, but its molecular mechanisms have not been delineated. Here using the models of tissue turnover, cancer immunosurveillance, and hematopoietic stem cells, we show that unwanted cells such as aging neutrophils and living cancer cells are susceptible to "labeling" by secreted calreticulin (CRT) from macrophages, enabling their clearance through PrCR. Importantly, we identified asialoglycans on the target cells to which CRT binds to regulate PrCR, and the availability of such CRT-binding sites on cancer cells correlated with the prognosis of patients in various malignancies. Our study reveals a general mechanism of target cell recognition by macrophages, which is the key for the removal of unwanted cells by PrCR in physiological and pathophysiological processes.
Telehealth services may improve access to care, but there are concerns around whether availability of telehealth may increase care utilization. We assessed whether usage of telehealth was associated ...with differential primary care utilization at a large, urban public healthcare system. Using electronic health record data from 23 primary care clinics, we categorized patients as telehealth users and non-users. Then, we compared the number of visits per patient between groups using Welch’s t-tests while stratifying by comorbidity count. We used multivariable Poisson regression to test for associations between telehealth usage and visit count while controlling for other demographic factors. Compared with telehealth non-users, telehealth users had approximately 1 more primary care visit per patient over the year regardless of comorbidity count or other patient characteristics. Availability of telehealth services may be associated with increased primary care utilization in a safety-net setting, though further research on outcomes, costs of care, and patient and clinician experiences is needed to better inform decisions regarding provision and reimbursement of telehealth services.
Biologists have long tried to describe and name the different phenotypes that make up the shell polymorphism of the land snail Cepaea nemoralis. Traditionally, the view is that the ground colour of ...the shell is one of a few major colour classes, either yellow, pink or brown, but in practise it is frequently difficult to distinguish the colours, and define different shades of the same colour. To understand whether colour variation is in reality continuous, and to investigate how the variation may be perceived by an avian predator, we applied psychophysical models of colour vision to shell reflectance measures. We found that both achromatic and chromatic variation are indiscrete in Cepaea nemoralis, being continuously distributed over many perceptual units. Nonetheless, clustering analysis based on the density of the distribution did reveal three groups, roughly corresponding to human-perceived yellow, pink and brown shells. We also found large-scale geographic variation in the frequency of these groups across Europe, and some covariance between shell colour and banding patterns. Although further studies are necessary, the observation of continuous variation in colour is intriguing because the traditional theory is that the underlying supergene that determines colour has evolved to prevent phenotypes from "dissolving" into continuous trait distributions. The findings thus have significance for understanding the Cepaea polymorphism, and the nature of the selection that acts upon it, as well as more generally highlighting the need to measure colour objectively in other systems.
In this experience sampling study, the authors examined the role of organizational leaders in employees' emotional experiences. Data were collected from health care workers 4 times a day for 2 weeks. ...Results indicate supervisors were associated with employee emotions in 3 ways: (a) Employees experienced fewer positive emotions when interacting with their supervisors as compared with interactions with coworkers and customers; (b) employees with supervisors high on transformational leadership experienced more positive emotions throughout the workday, including interactions with coworkers and customers; and (c) employees who regulated their emotions experienced decreased job satisfaction and increased stress, but those with supervisors high on transformational leadership were less likely to experience decreased job satisfaction. The results also suggest that the effects of emotional regulation on stress are long lasting (up to 2 hr) and not easily reduced by leadership behaviors.
Extracellular vesicles (EVs) have emerged as pivotal mediators of communication in the tumour microenvironment. More specifically, nanosized extracellular vesicles termed exosomes have been shown to ...contribute to the establishment of a premetastatic niche. Here, we sought to determine what role exosomes play in medulloblastoma (MB) progression and elucidate the underlying mechanisms. Metastatic MB cells (D458 and CHLA-01R) were found to secrete markedly more exosomes compared to their nonmetastatic, primary counterparts (D425 and CHLA-01). In addition, metastatic cell-derived exosomes significantly enhanced the migration and invasiveness of primary MB cells in transwell migration assays. Protease microarray analysis identified that matrix metalloproteinase-2 (MMP-2) was enriched in metastatic cells, and zymography and flow cytometry assays of metastatic exosomes demonstrated higher levels of functionally active MMP-2 on their external surface. Stable genetic knockdown of MMP-2 or extracellular matrix metalloproteinase inducer (EMMPRIN) in metastatic MB cells resulted in the loss of this promigratory effect. Analysis of serial patient cerebrospinal fluid (CSF) samples showed an increase in MMP-2 activity in three out of four patients as the tumour progressed. This study demonstrates the importance of EMMPRIN and MMP-2-associated exosomes in creating a favourable environment to drive medulloblastoma metastasis via extracellular matrix signalling.
The nature of shell growth in gastropods is useful because it preserves the ontogeny of shape, colour, and banding patterns, making them an ideal system for understanding how inherited variation ...develops, is established and maintained within a population. However, qualitative scoring of inherited shell characters means there is a lack of knowledge regarding the mechanisms that control fine variation. Here, we combine empirical measures of quantitative variation and 3D modeling of shells to understand how bands are placed and interact. By comparing five‐banded Cepaea individuals to shells lacking individual bands, we show that individual band absence has minor but significant impacts upon the position of remaining bands, implying that the locus controlling band presence/absence mainly acts after position is established. Then, we show that the shell grows at a similar rate, except for the region below the lowermost band. This demonstrates that wider bands of Cepaea are not an artifact of greater shell growth on the lower shell; they begin wider and grow at the same rate as other bands. Finally, we show that 3D models of shell shape and banding pattern, inferred from 2D photos using ShellShaper software, are congruent with empirical measures. This work therefore establishes a method that may be used for comparative studies of quantitative banding variation in snail shells, extraction of growth parameters, and morphometrics. In the future, studies that link the banding phenotype to the network of shell matrix proteins involved in biomineralization and patterning may ultimately aid in understanding the diversity of shell forms found in molluscs.
The qualitative scoring of snail shell banding means there is a lack of knowledge regarding the mechanisms that control fine variation. Here, we combine empirical measures of quantitative variation and 3D modelling of shells to show that the locus controlling band presence/absence mainly acts after band position is established. The work establishes a method that may be used for comparative studies of quantitative banding variation in snail shells, extraction of growth parameters, and morphometrics.
This article explores one of the undeniable driving forces in health care: payment, and the shift toward value-based reimbursement as a lever to better align provider incentives toward appropriate ...utilization of health care services. The increasing burden of heart failure has made it an attractive target for many payment reform efforts and alternative payment models. As the ultimate goal of "value-based care" interventions is to reduce costs and improve quality outcomes and experience for patients while simultaneously improving the caregiver experience, financial models require a level of clinical translation to yield sustainable care redesign improvements.
Understanding the impact of prior infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the response to vaccination is a priority for responding to the coronavirus disease ...2019 (COVID-19) pandemic. In particular, it is necessary to understand how prior infection plus vaccination can modulate immune responses against variants of concern. To address this, we sampled 20 individuals with and 25 individuals without confirmed previous SARS-CoV-2 infection from a large cohort of health care workers followed serologically since April 2020. All 45 individuals had received two doses of the Pfizer-BioNTech BNT162b2 vaccine with a delayed booster at 10 weeks. Absolute and neutralizing antibody titers against wild-type SARS-CoV-2 and variants were measured using enzyme immunoassays and pseudotype neutralization assays. We observed antibody reactivity against lineage A, B.1.351, and P.1 variants with increasing antigenic exposure, through either vaccination or natural infection. This improvement was further confirmed in neutralization assays using fixed dilutions of serum samples. The impact of antigenic exposure was more evident in enzyme immunoassays measuring SARS-CoV-2 spike protein–specific IgG antibody concentrations. Our data show that multiple exposures to SARS-CoV-2 spike protein in the context of a delayed booster expand the neutralizing breadth of the antibody response to neutralization-resistant SARS-CoV-2 variants. This suggests that additional vaccine boosts may be beneficial in improving immune responses against future SARS-CoV-2 variants of concern.
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